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PIOPED II, PISAPED and CTPA Criteria for Diagnosis of Pulmonary Embolus

Efficacy and continued technical improvements in CT pulmonary angiography (CTPA) have produced a significant rise in its use for the diagnosis of acute pulmonary embolism (PE). The growth of CTPA has produced a corresponding reduction in the utilization of pulmonary scintigraphy to the extent that some publications have suggested that lung scanning has become a second-line test. Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) interpretation criteria has been utilized to diagnose acute PE. More recently, a simplified algorithm comprising pulmonary perfusion scan along with prospective investigative study of pulmonary embolism diagnosis (PISAPED) interpretation criteria has shown a reduction of intermediate probability as one of the lung scan readings generated by the modified PIOPED criteria and has improved the sensitivity and specificity of the lung scintigraphy along with the modified PIOPED criteria to detect acute PE. Continue reading “PIOPED II, PISAPED and CTPA Criteria for Diagnosis of Pulmonary Embolus”

Diagnostic Criteria for Idiopathic Pulmonary Fibrosis (IPF)

In 2000, IPF was defined as a specific form of chronic, progressive, fibrosing interstitial pneumonia of unknown cause, occurring primarily in older adults and limited to the lungs. Usual interstitial pneumonia (UIP) is the histopathological pattern of IPF. IPF is characterized by progressive worsening of dyspnea and lung function and is associated with a poor prognosis. Continue reading “Diagnostic Criteria for Idiopathic Pulmonary Fibrosis (IPF)”

Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis

The Wells Clinical Prediction Rule is a diagnostic tool used during review of systems to identify possible pulmonary embolism (PE) and deep vein thrombosis (DVT). Continue reading “Wells Clinical Prediction Rule for Pulmonary Embolism and Deep Venous Thrombosis”

ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy

Major Criteria

  1. Exclusion of other known causes of ILD such as certain drug toxicities, environmental exposures, and connective tissue diseases

  2. Abnormal pulmonary function studies that include evidence of restriction (reduced VC, often with an increased FEV1/FVC ratio) and impaired gas exchange [increased P(A–a)O2, decreased PaO2 with rest or exercise or decreased DLCO]

  3. Bibasilar reticular abnormalities with minimal ground glass opacities on HRCT scans

  4. Transbronchial lung biopsy or BAL showing no features to support an alternative diagnosis

    Continue reading “ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy”

GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity

The European Respiratory Society (ERS) diagnostic criteria for COPD include the following symptoms: coughing, sputum production and/or dyspnoea, as well as a history of exposure to risk factors for COPD. The diagnosis is confirmed by a post-bronchodilator FEV1/FVC < 0.7 in spirometry, as sign of the airflow limitation that is not fully reversible.

Continue reading “GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity”

Diagnostic Criteria for Amiodarone-Induced Pulmonary Toxicity (APT)

The clinical diagnosis of amiodarone-induced pulmonary toxicity (APT) requires two or more of the following criteria:

  1. new onset of pulmonary symptoms such as dyspnea, cough, or pleuritic chest pain;
  2. new chest radiographic abnormality such as an interstitial or alveolar infiltrate;
  3. a decrease in the DLCO of 20% from the pretreatment value, or if none is available, a value less than 80% of predicted;
  4. abnormal lung uptake with gallium-67 radioisotope; and
  5. characteristic histologic changes of lung tissue obtained by bronchoscopic or open lung biopsy.

Continue reading “Diagnostic Criteria for Amiodarone-Induced Pulmonary Toxicity (APT)”

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